Impact of prehospital airway management on combat mortality.

INTRODUCTION: Analysis of modern military conflicts suggests that airway compromise remains the second leading cause of preventable death of combat fatalities. This study compares outcomes of combat casualties that received prehospital airway interventions, specifically bag valve mask (BVM) ventilation, cricothyrotomy, and supraglottic airway (SGA) placement. The goal is to compare the effectiveness of airway management strategies used in the military pre-hospital setting. METHODS: This retrospective chart review of 1267 US Army medical evacuation patient care records, compared outcomes of casualties that received prehospital advanced airway interventions. The patients consisted of US military injured in Operation Enduring Freedom January 2011-March 2014. Compared outcomes consisted of vent-, ICU-, and hospital-free days. RESULTS: Those with SGA placement experienced fewer vent-free days, ICU-free days, and hospital-free days compared to BVM and cricothyrotomy patients. The groups did not significantly differ in rates of 30-day survival. The odds for survival were not significantly higher for BVM versus SGA patients (OR 1.5, 95% CI 0.2-9.8), cricothyrotomy versus SGA patients (OR 3.9, 95% CI 0.6-24.9), or cricothyrotomy versus BVM patients (OR 2.7, 95% CI 0.5-13.8) in a logistic regression model adjusting for GCS. CONCLUSION: This study supports prehospital BVM ventilation as a possible alternative to cricothyrotomy as there was no difference in measured outcomes between the groups. It further cautions against SGA use in the prehospital combat setting due to higher morbidity demonstrated by fewer ventilator, hospital, and ICU free days than those receiving cricothyrotomy or BVM ventilation. There was no difference in 30-day survival between the groups.

COVID-19 and Fidelity to the Sobriety Treatment and Recovery Teams Model.

OBJECTIVE: Quick access to substance use treatment is associated with better outcomes, but little is known about COVID-19's impact on access and retention. This study examined the relationship between COVID-19-related practice changes and quick access fidelity outcomes of the Sobriety Treatment and Recovery Teams (START) program, which serves families with co-occurring substance use and child abuse/neglect. METHOD: This study was a retrospective cohort comparison. On March 23, 2020, most START child welfare and treatment services were shifted to a virtual format because of the COVID-19 pandemic. Families referred to the program between that date and March 23, 2021, were compared with families served the year before (i.e., March 23, 2019, to March 22, 2020). Cohorts were compared across nine fidelity outcomes (e.g., number of days to complete four treatment sessions), with differences assessed using chi-square tests and independent samples t tests. RESULTS: Referrals to START were 14% lower during the first COVID-19 year than in the prior year, with a greater percentage of referred cases being accepted during COVID-19. Transition to virtual service provision was not related to quick access fidelity outcomes; however, adults referred in the year before COVID-19 were more likely to complete four treatment sessions than adults referred during the first COVID-19 year. CONCLUSIONS: In this study, quick access to services and initial engagement did not appear to be negatively affected by virtual service provision resulting from COVID-19. However, during COVID-19, fewer adults completed four treatment sessions. In a largely virtual treatment environment, additional engagement and pre-treatment services may be necessary.

Heated Ultrasound Gel and Patient Satisfaction with Bedside Ultrasound Studies: The HUGS Trial.

INTRODUCTION: Our goal was to determine if heated gel for emergency department (ED) bedside ultrasonography improves patient satisfaction compared to room-temperature gel. METHODS: We randomized a convenience sample of ED patients determined by their treating physician to require a bedside ultrasound (US) study to either heated gel (102.0° F) or room-temperature gel (82.3° F). Investigators performed all US examinations. We informed all subjects that the study entailed investigation into various measures to improve patient satisfaction with ED US examinations but did not inform them of our specific focus on gel temperature. Investigators wore heat-resistant gloves while performing the examinations to blind themselves to the gel temperature. After completion of the US, subjects completed a survey including the primary outcome measure of patient satisfaction as measured on a 100-mm visual analogue scale (VAS). A secondary outcome was patient perceptions of sonographer professionalism measured by an ordinal scale (1-5). RESULTS: We enrolled 124 subjects; 120 completed all outcome measures. Of these, 59 underwent randomization to US studies with room-temperature gel and 61 underwent randomization to heated US gel. Patient 100-mm VAS satisfaction scores were 83.9 among patients undergoing studies with room-temperature gel versus 87.6 among subjects undergoing studies with heated gel (effect size 3.7, 95% confidence interval -1.3-8.6). There were similarly no differences between the two arms with regard to patient perceptions of sonographer professionalism. CONCLUSION: The use of heated ultrasound gel appears to have no material impact on the satisfaction of ED patients undergoing bedside ultrasound studies.